Yuhei Kayukawa

Daytime sleepiness and automobile accidents in patients with obstructive sleep apnea syndrome.

Abstract We evaluated the rate of automobile accidents and daytime sleepiness using the Epworth sleepiness scale (ESS) in 44 patients with obstructive sleep apnea syndrome (OSAS). We defined the automobile accident score as a sum of two points for every one automobile accident and one point for every near‐miss accident. Automobile accidents and near‐misses were found in 54.5% and 50.0% in patients with OSAS. Automobile accident score was significantly correlated with the ESS score (r= 0.56, P < 0.01). Our findings suggest that ESS score may be useful in detecting patients with the potential risk of automobile accidents associated with daytime sleepiness.

Cross-regional survey of seasonal affective disorders in adults and high-school students in Japan

BACKGROUND In Asian countries, there is no epidemiological report on seasonal affective disorder (SAD) in different age groups and different geographic regions surveyed at the same time. The aim of this study was to estimate the prevalence rates of SAD and risk factors for SAD in adults and high-school students, with special reference to the difference of winter SAD between northern and southern regions in Japan. METHODS A total of 3237 high-school students and 4858 workers living in Japan (31.3-43.5 degrees N) responded to this epidemiological survey using Japanese version of the Seasonal Pattern Assessment Questionnaire (SPAQ). RESULTS The overall prevalence rates of winter SAD (subsyndromal winter SAD) and summer SAD (subsyndromal summer SAD) in high-school students were 0.91(2.21) and 0.81(2.57)%, respectively. In workers, these rates were 0.45(1.16) and 0.43(0.71)%, respectively. Although no regional difference was noted in high-school students with winter seasonal type, the estimated odds ratio of this type for northern workers was nearly 3-fold higher than the southern counterparts. The prevalence rates of each seasonal type were not significantly different between two sexes in both age groups. No clear dependence on latitude was seen with regard to summer SAD in both age groups. LIMITATIONS The effect of climate on SAD could not be entirely excluded from geophysical factor as indexed by latitude. CONCLUSIONS SAD was less common in adults than in high-school students. While latitude was a major determinant of winter type in adults, socio-cultural factors or other contributing factors might affect the development of this type in high-school students.

Risk factors for obstructive sleep apnea syndrome screening in mood disorder patients

Aims:  Previous studies have reported that the incidence of obstructive sleep apnea syndrome (OSAS) in patients with depression is higher than in the general population. We examined the risk factors to predict OSAS in mood disorder patients with depressive symptoms.

Habitual snoring in an outpatient population in Japan

Abstract In order to investigate the occurrence and history of sleep problems in Japan, the 11‐Centre Collaborative Study on Sleep Problems (COSP) project was carried out. Complaints of snoring are examined, and its prevalence, risk factors and screening reliability are discussed. The subjects who participated in the study were 6445 new outpatients from a general hospital. They were asked to answer a sleep questionnaire that consisted of 34 items with seven demographic items; each item was composed of four grades of frequency. In order to offset possible seasonal variations in sleep habits, data were collected across four seasons. Sleep patterns, insomnia, hypersomnia, parasomnia and circadian rhythm sleep disorders were covered. Habitual snoring was seen in 16.0% of males and 6.5% of females. Male predominance was noted. From these data, the relationship between habitual snoring and sleep complaints was statistically analyzed. Habitual snorers (HS) were observed to wake up more frequently during sleep (17.8% of males, 21.5% of females) than were non‐habitual snorers (NHS; 6.6% of males, 9.7% of females). Mid‐sleep awakening of HS was also more frequent than it was for NHS; however, there were no differences in difficulty in falling asleep and early morning awakening. Body mass index, cigarette smoking and alcohol consumption were also correlated with habitual snoring.

Unusual cases of presenile dementia with Fahr's syndrome

Abstract: Three patients with an unusual type of presenile dementia were studied. Atypical clinical pictures emerged from an evaluation of these cases. Their symptoms and signs were thought to be neither those of Alzheimers disease nor those of Picks disease but a partial mixture of those of both diseases. The neuropathological changes were characteristic and the common findings were as as follows: 1) the absence of senile plaques, 2) the widespread presence of numerous neurofibrillary tangles, 3) a calcareous deposition of Fahrs type, 4) a circumscribed cerebral atrophy in the temporal or/and frontal lobes, 5) a moderate or severe demyelination and fibrous gliosis in the white matter of the atrophied areas, and 6) a slight or moderate neuronal loss in the nucleus basalis of Meynert. Similar cases reported previously were reviewed.

Ultra‐low‐field magnetic resonance imaging in upper airways obstruction in sleep apnea syndrome

Abstract The hypothesis that the sites of upper airways obstruction (U AO) are varied in a patient with obstructive sleep apnea syndrome (OSAS) among different sleep stages is studied. Four patients with OSAS underwent ultra‐low‐field magnetic resonance imaging (MRI) with a field strength of 0.064 Tesla provided real‐time images and generated less noise and necessitated less strict magnetic isolation compared with conventional high‐field MRI. After the fixed end‐apneic sleep stage was determined, the polysomnogram was switched off and ultra‐low‐field MRI was commenced. The effects of continuous positive airway pressure (CPAP) on the upper airway patency in the deepest sleep stage obtained for each patient was assessed. Upper airway obstruction was found at the level of the palatopharynx (PP) at sleep onset extended to the glossopharynx (GP) during rapid eye movement (REM) sleep in two cases and during NREM sleep in one case. This combined PP and GP obstruction was observed from sleep onset and remained unchanged in one case. The patent upper airways were observed during treatment with CPAP during REM sleep in two patients and during stage two of NREM sleep in the other two patients. It can be concluded that the sites of UAO vary in a patient with OSAS in different sleep stages. The results also suggest the use of the ultra‐low‐field MRI in order to visualize the dynamic and real‐time behaviors of the upper airways during sleep in patients with OSAS.

Sleep problems in the aged in relation to senility

Abstract As a part of an epidemiologic survey of dementia in a community of aged persons, correlation between sleep complaints and physical illness and senility were studied. A total of 3302 randomly sampled aged individuals (aged 65 yean) were studied using a questionnaire. In this sample the prevalence of poor sleep and habitual snoring did not increase with age. The prevalence of excessive daytime sleepiness showed an increase with age. Male predominance of habitual snoring and female predominance of poor sleep were observed. Female predominance of excessive daytime sleepiness was noted among the aged 70 and over. Age‐related excessive daytime sleepiness was significantly correlated with senility.

Differences in arousal response between aged and middle-aged patients with obstructive sleep apnea syndrome.

Abstract The aim of this study is to show the clinical significance of the differences in arousal response at a termination of apnea/hypopnea between aged and middle‐aged patients with obstructive sleep apnea syndrome (OSAS). We polygraphically assessed electrocardiographic (ECG) and electroencephalographic (EEG) arousal. Electrocardiographic arousal was defined as an abrupt increase in heart rate at a termination of apnea/hypopnea. Our findings showed that EEG and ECG arousal at a termination of apnea/hypopnea were significantly suppressed in aged patients with OSAS, which might provide useful information on the pathophysiology of OSAS.

Evaluating mental fatigue in patients with obstructive sleep apnea syndrome by the Maastricht Questionnaire

Abstract Mental fatigue in patients with obstructive sleep apnea syndrome (OSAS) was investigated and compared with subjects without OSAS. The study series comprised 189 habitual snoring patients and 75 controls. To measure subjective mental fatigue and somnolence, subjects were asked to complete the Maastricht Questionnaire (MQ) and the Epworth Sleepiness Scale (ESS), respectively, and patients also underwent diagnostic polysomnography. According to the apnea and hypopnea index, patients were classified into the following groups: primary snorers, or having mild, moderate, or severe OSAS. The lowest MQ and highest ESS scores were found in those patients with severe OSAS. It is proposed that the lowest MQ score is due to mental fatigue impairing awareness in patients with severe OSAS, probably because of attention loss.

A survey of habitual snoring in centenarians

OBJECTIVE: To ascertain whether centenarians in the surveyed group would be nonhabitual snorers.